Tuesday, January 16, 2007

This is the ninth survey in the series of anonymous surveys asking active duty service members about various lifestyle and health-related behaviors. In addition to substance use, the survey also assesses national health status goals from the Department of Health and Human Services’ Healthy People 2010 objectives, nutrition and weight management measures, mental well-being of the force, and deployment issues. More than 16,000 service members, randomly selected to represent men and women in all pay grades of the active force throughout the world, completed the survey.

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First, some of the good news:

The findings show notable decreases in the use of cigarettes and illegal drugs since initiation of the surveys in 1980 and progress towards meeting selected Healthy People 2010 objectives. The 2005 survey, however, revealed rates of heavy drinking remain elevated especially among our young people, use of smokeless tobacco has increased, and even though most military personnel engage in moderate or vigorous exercise, more service members meet criteria for being overweight.

The 2005 survey indicates the majority of our U.S. Armed Forces, although under heavy work stress during the current wartime environment, use positive coping mechanisms to deal with stress.

According to Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, “These survey findings provide very useful information for the department to target programs that continue to enhance the physical and mental well being of our troops. I am pleased, and even a little surprised, that despite the stresses of war and ongoing deployments, nearly all indicators of service members’ health and well-being continue to be quite good compared with civilian populations.”

Regarding PTSD and the relationship between self-medication and mental health:

Rates of current (one month) Post Traumatic Stress Disorder (PTSD) symptoms in the DoD population as measured by a self-report screener were 6.7 percent for total DoD and ranged from 3.7 percent to 9.3 percent for each service. An estimated 8.1 percent met screening criteria for further evaluation for serious psychological distress.

“It is important to remember the results come from self reported data and may differ from information in official records or other data sources,”Winkenwerder noted. “These screening questions do not represent a formal clinical diagnostic evaluation, but suggest some of our personnel should be encouraged to obtain more evaluation.”

Personnel deployed in the past three years (i.e., from 2002 to 2005), compared to those who did not deploy, had higher rates of work and family stress; higher rates of heavy alcohol use, cigarette use, and illicit drug use; and a greater number meeting criteria for depression, anxiety and PTSD symptoms on the screening questions. In contrast, there were no significant differences in self-reported mental health measures among those deployed to OIF/OEF compared to those who did not serve in an operational theater.

Statistically significant relations were observed among heavy alcohol use, stress, and mental health issues. Compared with abstainers, heavy users of alcohol reported more problems with stress at work (41.1 percent vs. 28.4 percent) or in their family (24.7 percent vs. 15.3 percent); were more likely to meet screening criteria for anxiety (17.5 percent vs. 10.1 percent) and depression (31.2 percent vs. 19.1 percent); and reported more limitations in activities as a result of poor mental health (4.8 percent vs. 2.0 percent).

Heavy drinkers were also more likely than those who drank less to meet the criteria for further evaluation for serious mental disorders and reported to have a history of suicidal ideation or physical or sexual abuse.

However, because the survey is cross-sectional data, we are unable to ascertain which behavior (the heavy alcohol use or the mental health problems) came first, but this association points to potential intervention strategies in which reducing one would help reduce the other .(e.g., encouraging more positive coping strategies could both lessen use of alcohol and improve mental health).

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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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